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Nirmatrelvir and Ritonavir side effects: what 53,818 FDA adverse event reports show

Nirmatrelvir And Ritonavir · Paxlovid · 1,046 reaction terms · 138,867 drug–reaction co-reports · data 2026-09-14
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Drug class

Not stated in label

Brand names

Paxlovid

openFDA label

Who reports

53,818 reports · 18% serious · 557 with death outcome · 65% female

openFDA FAERS counts, all years, deduplication not applied

Used for

PAXLOVID is indicated for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults who are at high risk for progression to severe COVID-19, including hospitalization or death. PAXLOVID which includes nirmatrelvir, a severe acute .

FDA label, Indications and Usage

What it is

PAXLOVID is nirmatrelvir tablets co-packaged with ritonavir tablets. Nirmatrelvir is a SARS-CoV-2 main protease (M pro ) inhibitor, and ritonavir is an HIV-1 protease inhibitor and CYP3A inhibitor. Nirmatrelvir

FDA label, Description section

Boxed warning

SIGNIFICANT DRUG INTERACTIONS WITH PAXLOVID • PAXLOVID includes ritonavir, a strong CYP3A inhibitor, which may lead to greater exposure of certain concomitant medications, resulting in potentially severe, life-threatening, or fatal events [see Contraindications (4) , Warnings and Precautions (5.1) , and Drug Interactions (7) ].

FDA label
How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Labeled adverse reaction 1Labeled (related wording) 2Likely indication confounding 1Reporting / coding artifact 17Lab value / disease marker 3Not in label — unassessed 16
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only (and, for the 300 most-reported drugs, adjusted for age band), and flags pairs whose reports are unusually skewed by sex or come mostly from consumers. Each row also shows the PRR against the other drugs of the same FDA class, which removes most confounding by the condition being treated, and a calibrated p-value: on validation, known non-causes average an ROR of about 2, so significance is judged against that empirical null (✓ = p < 0.05 after calibration). 1,006 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Disease recurrence20,103285.7
281.1–290.3ROR 455.4 · calibrated p 1e-13 ✓
164.1 EB05 162.2 · IC025 +7.3
3/3 methods agree
Reporting / coding artifactserious PRR 43.3 · 80% consumernot reported in cached trials
Asymptomatic covid-197083.1
64.2–107.6ROR 83.2 · calibrated p 7e-7 ✓
67.3 EB05 55.1 · IC025 +5.1
3/3 methods agree
Not in label — unassessedserious n=4 · ♀ 43% (drug 65%) · 86% consumernot reported in cached trials
Symptom recurrence99479.5
74.3–85.1ROR 81.0 · calibrated p 5e-7 ✓
65.9 EB05 62.6 · IC025 +5.9
3/3 methods agree
Not in label — unassessedserious n=71 · 77% consumernot reported in cached trials
Covid-1922,81557.6
57.0–58.3ROR 99.3 · calibrated p 1e-7 ✓
50.2 EB05 49.7 · IC025 +5.6
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious PRR 24.2 · 78% consumernot reported in cached trials
Sars-cov-2 test negative7346.5
36.5–59.3ROR 46.6 · calibrated p 3e-5 ✓
41.2 EB05 33.8 · IC025 +4.6
3/3 methods agree
Reporting / coding artifactserious n=37 · 86% consumernot reported in cached trials
Dysgeusia (altered taste)7,34842.5
41.5–43.4ROR 49.0 · calibrated p 2e-5 ✓
38.3 EB05 37.6 · IC025 +5.2
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 39.5 · 81% consumerNCT05263908: 189/2,829 (6.7%) on Nirmatrelvir and Ritonavir
Contraindicated product prescribed12932.5
27.2–38.9ROR 32.6 · calibrated p 2e-4 ✓
30.0 EB05 25.9 · IC025 +4.5
3/3 methods agree
Reporting / coding artifactserious n=6 · ♀ 43% (drug 65%)not reported in cached trials
Post-acute covid-19 syndrome8428.4
22.7–35.4ROR 28.4 · calibrated p 4e-4 ✓
26.3 EB05 21.9 · IC025 +4.2
3/3 methods agree
Not in label — unassessedserious n=28 · 79% consumernot reported in cached trials
Immunosuppressant drug level increased18923.7
20.4–27.4ROR 23.7 · calibrated p 9e-4 ✓
22.3 EB05 19.8 · IC025 +4.2
3/3 methods agree
Lab value / disease markerserious n=179 · ♀ 41% (drug 65%)not reported in cached trials
Taste disorder1,04521.4
20.1–22.8ROR 21.8 · calibrated p 0.001 ✓
20.3 EB05 19.3 · IC025 +4.2
3/3 methods agree
Not in label — unassessedserious PRR 25.2 · 79% consumerNCT05263908: 48/2,829 (1.7%) on Nirmatrelvir and Ritonavir
Product dose confusion1720.5
12.6–33.4ROR 20.5 · calibrated p 0.003 ✓
19.0 EB05 12.3 · IC025 +2.9
3/3 methods agree
Reporting / coding artifact–not reported in cached trials
Sars-cov-2 test positive62919.2
17.7–20.8ROR 19.4 · calibrated p 0.002 ✓
18.3 EB05 17.2 · IC025 +4.0
3/3 methods agree
Lab value / disease markerserious n=275 · 76% consumernot reported in cached trials
Upper respiratory tract congestion13518.8
15.9–22.4ROR 18.9 · calibrated p 0.003 ✓
18.0 EB05 15.6 · IC025 +3.8
3/3 methods agree
Not in label — unassessedserious n=9 · 86% consumernot reported in cached trials
Product taste abnormal56617.1
15.7–18.6ROR 17.3 · calibrated p 0.004 ✓
16.4 EB05 15.3 · IC025 +3.9
3/3 methods agree
Reporting / coding artifactserious n=58 · 83% consumernot reported in cached trials
Product prescribing error96816.6
15.5–17.7ROR 16.9 · calibrated p 0.004 ✓
15.9 EB05 15.1 · IC025 +3.9
3/3 methods agree
Reporting / coding artifactserious PRR 7.5not reported in cached trials
Product blister packaging issue3915.3
11.1–21.1ROR 15.3 · calibrated p 0.008 ✓
14.6 EB05 11.0 · IC025 +3.1
3/3 methods agree
Reporting / coding artifact71% consumernot reported in cached trials
Incorrect product administration duration73614.6
13.6–15.7ROR 14.8 · calibrated p 0.007 ✓
14.1 EB05 13.3 · IC025 +3.7
3/3 methods agree
Reporting / coding artifactserious n=105not reported in cached trials
Product after taste2912.4
8.6–18.0ROR 12.4 · calibrated p 0.018 ✓
11.5 EB05 8.1 · IC025 +2.7
3/3 methods agree
Reporting / coding artifactserious n=5 · 86% consumernot reported in cached trials
Coronavirus test positive3212.3
8.7–17.5ROR 12.3 · calibrated p 0.018 ✓
11.5 EB05 8.3 · IC025 +2.8
3/3 methods agree
Lab value / disease markerserious n=14 · 91% consumernot reported in cached trials
Faeces pale6712.1
9.5–15.5ROR 12.1 · calibrated p 0.018 ✓
11.6 EB05 9.3 · IC025 +3.0
3/3 methods agree
Not in label — unassessedserious n=19 · 79% consumernot reported in cached trials
Rebound effect34212.1
10.9–13.5ROR 12.2 · calibrated p 0.016 ✓
11.7 EB05 10.7 · IC025 +3.4
3/3 methods agree
Not in label — unassessedserious PRR 33.2not reported in cached trials
Product size issue14510.9
9.2–12.9ROR 10.9 · calibrated p 0.025 ✓
10.5 EB05 9.1 · IC025 +3.1
3/3 methods agree
Reporting / coding artifactserious n=32not reported in cached trials
Labelled drug-drug interaction issue3810.8
7.8–14.9ROR 10.8 · calibrated p 0.028 ✓
10.0 EB05 7.5 · IC025 +2.7
3/3 methods agree
Reporting / coding artifactserious n=26 · ♀ 44% (drug 65%)not reported in cached trials
Tongue erythema2110.3
6.7–15.9ROR 10.3 · calibrated p 0.037 ✓
9.1 EB05 6.0 · IC025 +2.3
3/3 methods agree
Not in label — unassessedserious n=7 · 81% consumernot reported in cached trials
Product packaging confusion599.7
7.5–12.5ROR 9.7 · calibrated p 0.039 ✓
9.1 EB05 7.2 · IC025 +2.7
3/3 methods agree
Reporting / coding artifactserious n=5not reported in cached trials
Nasal congestion (stuffy nose)1,3679.3
8.8–9.8ROR 9.5 · calibrated p 0.038 ✓
9.1 EB05 8.7 · IC025 +3.1
3/3 methods agree
Not in label — unassessedserious PRR 7.6 · 82% consumernot reported in cached trials
Tongue coated399.0
6.5–12.3ROR 9.0 · calibrated p 0.051
8.3 EB05 6.2 · IC025 +2.5
3/3 methods agree
Not in label — unassessedserious n=6 · ♀ 85% (drug 65%) · 82% consumernot reported in cached trials
Contraindicated product administered6748.9
8.2–9.6ROR 9.0 · calibrated p 0.046 ✓
8.7 EB05 8.1 · IC025 +3.0
3/3 methods agree
Reporting / coding artifactserious PRR 7.0not reported in cached trials
Sneezing4788.5
7.8–9.3ROR 8.6 · calibrated p 0.054
8.3 EB05 7.7 · IC025 +2.9
3/3 methods agree
Not in label — unassessedserious PRR 6.7 · 85% consumernot reported in cached trials
Sinus pain488.3
6.2–11.0ROR 8.3 · calibrated p 0.065
7.7 EB05 6.0 · IC025 +2.4
3/3 methods agree
Not in label — unassessedserious n=9 · 87% consumernot reported in cached trials
Prescription drug used without a prescription1278.3
6.9–9.8ROR 8.3 · calibrated p 0.062
7.9 EB05 6.8 · IC025 +2.7
3/3 methods agree
Not in label — unassessedserious n=5 · 87% consumernot reported in cached trials
Paranasal sinus discomfort707.4
5.8–9.3ROR 7.4 · calibrated p 0.089
7.0 EB05 5.7 · IC025 +2.4
3/3 methods agree
Not in label — unassessedserious n=11 · 81% consumernot reported in cached trials
Product confusion147.1
4.2–12.1ROR 7.1 · calibrated p 0.116
5.9 EB05 3.7 · IC025 +1.6
3/3 methods agree
Reporting / coding artifact–not reported in cached trials
Rhinorrhoea (runny nose)1,0906.7
6.3–7.1ROR 6.8 · calibrated p 0.107
6.6 EB05 6.3 · IC025 +2.6
3/3 methods agree
Not in label — unassessedserious PRR 5.1 · 82% consumernot reported in cached trials
Product use complaint2536.4
5.7–7.3ROR 6.5 · calibrated p 0.124
6.3 EB05 5.7 · IC025 +2.4
3/3 methods agree
Reporting / coding artifactserious n=35not reported in cached trials
Anosmia (loss of smell)2306.3
5.5–7.1ROR 6.3 · calibrated p 0.134
6.1 EB05 5.5 · IC025 +2.4
3/3 methods agree
Not in label — unassessedserious n=54 · 84% consumernot reported in cached trials
Therapeutic product effect incomplete1,0806.0
5.7–6.4ROR 6.1 · calibrated p 0.142
5.9 EB05 5.6 · IC025 +2.5
3/3 methods agree
Reporting / coding artifactserious PRR 4.2 · 81% consumernot reported in cached trials
Product expiration date issue216.0
3.9–9.3ROR 6.0 · calibrated p 0.167
5.3 EB05 3.7 · IC025 +1.7
3/3 methods agree
Reporting / coding artifact–not reported in cached trials

Trial evidence (ClinicalTrials.gov)

✓ Trial adverse-event data found on ClinicalTrials.gov

Largest completed trials with posted results that list Nirmatrelvir and Ritonavir as a study intervention. The right-hand column of the signal table shows whether each FAERS term was also recorded in these trials, with a real denominator (2 of 40 signal terms matched).

Caveats: trial populations, doses and follow-up differ from the reporting population; AE terms are sponsor-coded and matched here by wording; absence from a trial list means the term was not reported above the sponsor's frequency threshold, not that it cannot occur.

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Covid-1922,81557.6
57.0–58.3ROR 99.3 · calibrated p 1e-7 ✓
50.2 EB05 49.7 · IC025 +5.6
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious PRR 24.2 · 78% consumernot reported in cached trials
Disease recurrence20,103285.7
281.1–290.3ROR 455.4 · calibrated p 1e-13 ✓
164.1 EB05 162.2 · IC025 +7.3
3/3 methods agree
Reporting / coding artifactserious PRR 43.3 · 80% consumernot reported in cached trials
Dysgeusia (altered taste)7,34842.5
41.5–43.4ROR 49.0 · calibrated p 2e-5 ✓
38.3 EB05 37.6 · IC025 +5.2
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 39.5 · 81% consumerNCT05263908: 189/2,829 (6.7%) on Nirmatrelvir and Ritonavir
Diarrhoea (diarrhea)4,0272.4
2.4–2.5ROR 2.6 · calibrated p 0.786
2.4 EB05 2.4 · IC025 +1.2
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 3.7 · 77% consumerNCT05263908: 92/2,829 (3.3%) on Nirmatrelvir and Ritonavir
Nausea2,6361.3
1.3–1.4ROR 1.3 · calibrated p 0.520
1.3 EB05 1.3 · IC025 +0.3Labeled adverse reaction
exact term
serious PRR 2.4 · 73% consumerNCT05263908: 2/2,829 (0.1%) on Nirmatrelvir and Ritonavir (serious AE)
Headache2,1781.4
1.3–1.4ROR 1.4 · calibrated p 0.556
1.4 EB05 1.3 · IC025 +0.4Labeled adverse reaction
exact term
serious PRR 2.1 · 80% consumerNCT05263908: 6/2,829 (0.2%) on Nirmatrelvir and Ritonavir
Cough2,0482.9
2.7–3.0ROR 2.9 · calibrated p 0.646
2.9 EB05 2.7 · IC025 +1.4
3/3 methods agree
Not in label — unassessedserious PRR 2.6 · 81% consumerNCT05263908: 5/2,829 (0.2%) on Nirmatrelvir and Ritonavir
Fatigue (tiredness)2,0141.0
1.0–1.1ROR 1.0 · calibrated p 0.313
1.0 EB05 1.0 · IC025 -0.1
PRR-only: not supported by EBGM or IC
Not in label — unassessedserious PRR 1.6 · 79% consumerNCT06291831: 4/2,005 (0.2%) on Nirmatrelvir and Ritonavir
Incorrect dose administered1,7173.0
2.9–3.1ROR 3.1 · calibrated p 0.609
3.0 EB05 2.9 · IC025 +1.5
3/3 methods agree
Reporting / coding artifactserious PRR 3.5not reported in cached trials
Vomiting1,4081.2
1.1–1.2ROR 1.2 · calibrated p 0.423
1.2 EB05 1.1 · IC025 +0.1Labeled adverse reaction
exact term
serious PRR 2.3NCT05263908: 1/2,829 (0.0%) on Nirmatrelvir and Ritonavir (serious AE)
Malaise (feeling unwell)1,3751.2
1.2–1.3ROR 1.2 · calibrated p 0.457
1.2 EB05 1.2 · IC025 +0.2Labeled adverse reaction
exact term
serious PRR 1.5 · 85% consumerNCT05263908: 12/2,829 (0.4%) on Nirmatrelvir and Ritonavir
Nasal congestion (stuffy nose)1,3679.3
8.8–9.8ROR 9.5 · calibrated p 0.038 ✓
9.1 EB05 8.7 · IC025 +3.1
3/3 methods agree
Not in label — unassessedserious PRR 7.6 · 82% consumernot reported in cached trials
Off label use (used outside approved label)1,3230.6
0.6–0.6ROR 0.6 · calibrated p 0.078
0.6 EB05 0.6 · IC025 -0.8
PRR-only: not supported by EBGM or IC
Reporting / coding artifactserious PRR 1.3not reported in cached trials
Drug interaction1,2993.2
3.0–3.4ROR 3.3 · calibrated p 0.547
3.2 EB05 3.0 · IC025 +1.6
3/3 methods agree
Reporting / coding artifactserious PRR 9.1not reported in cached trials
Pyrexia (fever)1,2551.4
1.3–1.5ROR 1.4 · calibrated p 0.591
1.4 EB05 1.3 · IC025 +0.4Not in label — unassessedserious PRR 1.1 · 79% consumerNCT05263908: 2/2,829 (0.1%) on Nirmatrelvir and Ritonavir (serious AE)

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

✓ A hand-written Bradford Hill causality assessment exists for this drug: Nirmatrelvir/ritonavir (Paxlovid) ↔ COVID-19 recurrence ("Paxlovid rebound").

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Nirmatrelvir and Ritonavir?

In FDA FAERS, the most frequently co-reported reaction terms for Nirmatrelvir and Ritonavir are covid-19, dysgeusia, diarrhoea, nausea, headache, cough. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Nirmatrelvir and Ritonavir have an FDA boxed warning?

Yes. The current FDA label carries a boxed warning: SIGNIFICANT DRUG INTERACTIONS WITH PAXLOVID • PAXLOVID includes ritonavir, a strong CYP3A inhibitor, which may lead to greater exposure of certain concomitant medications, resulting in potentially severe, life-threatening, or fatal events [see Contraindications (4) , Warnings and Precautions (5.1) , and Drug Interactions (7) ].

Do FAERS signals prove that Nirmatrelvir and Ritonavir causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-14. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.